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Jonathan Hoiles: Perhaps 2 Units in Traumatic Hemorrhagic Shock Isn’t Enough to Make a Meaningful Difference?
Jonathan Hoiles/LinkedIn
May 28, 2026, 21:30

Jonathan Hoiles: Perhaps 2 Units in Traumatic Hemorrhagic Shock Isn’t Enough to Make a Meaningful Difference?

Jonathan Hoiles, Manager of Transfusion Medicine and Blood Bank at Moffitt Cancer Center, shared on LinkedIn:

”Mixed messages?

Two similar studies recently published in the NEJM (TOWAR, a US study, and SWiFT, a UK study) reached similar conclusions: the use of up to 2 units of Whole Blood (WB) for injured pre-hospital patients with traumatic hemorrhagic shock is not superior to standard component therapy.

Yet, a systematic review of the literature published in Transfusion showed that WB is consistently associated with lower transfusion requirements compared to component therapy or crystalloids.

My take (perhaps a not-so-hot take?): 2 units of WB is insufficient for pre-hospital patients with traumatic hemorrhagic shock.

Given the large amounts of blood these massively bleeding patients require, perhaps 2 units isn’t enough to make a meaningful difference.”

Article 1: Prehospital Resuscitation with Type O Whole Blood for Trauma and Hemorrhage

Authors: Jason L. Sperry, Francis X. Guyette, Bryan A. Cotton, James F. Luther, Richard B. Utarnachitt, Matthew E. Kutcher, Brian J. Daley, Allan B. Peetz, Mayur B. Patel, Michael D. Goodman, Jeffrey A. Claridge, Nimitt Patel, Brian G. Harbrecht, Zain G. Hashmi, Ryan Zarychanski, Matthew D. Neal, Mark H. Yazer, Christian Martin-Gill, Laura E. Vincent, Ashley M. Harner, David E. Meyer, Andrew J. Latimer, Bryce R. Robinson, Catherine L. McKnight, William R. Hinckley, Keith R. Miller, Jan O. Jansen, Douglas Martin, Erin E. Fox, Bedda L. Rosario-Rivera, Stephen R. Wisniewski

Jonathan Hoiles: Perhaps 2 Units in Traumatic Hemorrhagic Shock Isn’t Enough to Make a Meaningful Difference?

Article 2: Prehospital Whole Blood in Traumatic Hemorrhage — a Randomized Controlled Trial

Authors: Jason E. Smith, Rebecca Cardigan, Emily Sanderson, Laura Silsby, Claire Rourke, Ed B.G. Barnard, Peter Basham, Grazia Antonacci, Richard Charlewood, Nikki Dallas, Jane Davies, Elizabeth Goodwin, Annie Hawton, Cara Hudson, Joanne Lucas, Katie Keen, Richard M. Lyon, Brodie Nolan, Gavin D. Perkins, Viona Rundell, Laura Smith, Simon J. Stanworth, Anne Weaver, Tom Woolley, Laura Green

Jonathan Hoiles: Perhaps 2 Units in Traumatic Hemorrhagic Shock Isn’t Enough to Make a Meaningful Difference?

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Allan B. Peetz Andrew J. Latimer Anne Weaver Annie Hawton Ashley M. Harner Bedda L. Rosario-Rivera Brian G. Harbrecht Brian J. Daley Brodie Nolan Bryan A. Cotton Bryce R. Robinson Cara Hudson Catherine L. McKnight Christian Martin-Gill Claire Rourke David E. Meyer Douglas Martin Ed B.G. Barnard Elizabeth Goodwin Emily Sanderson Erin E. Fox Francis X. Guyette Gavin D. Perkins Grazia Antonacci Health Hematology Hemostasis Hemostasis News Hemostasis Today James F. Luther Jan O. Jansen Jane Davies Jason E. Smith Jason L. Sperry Jeffrey A. Claridge Joanne Lucas Jonathan Hoiles Katie Keen Keith R. Miller Laura E. Vincent Laura Green Laura Silsby Laura Smith Mark H. Yazer Matthew D. Neal Matthew E. Kutcher Mayur B. Patel Medicine Michael D. Goodman NEJM Nikki Dallas Nimitt Patel Peter Basham Rebecca Cardigan Richard B. Utarnachitt Richard Charlewood Richard M. Lyon Ryan Zarychanski Simon J. Stanworth Stephen R. Wisniewski SWiFT Tom Woolley TOWAR Transfusion Medicine traumatic hemorrhage Viona Rundell Whole Blood William R. Hinckley Zain G. Hashmi
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